Intrapulmonary Schwannoma Diagnosed With Endobronchial

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Arch Bronconeumol. 2014;50(11):490–492
www.archbronconeumol.org
Case Report
Intrapulmonary Schwannoma Diagnosed With Endobronchial
Ultrasound-Guided Transbronchial Needle Aspiration: Case Report夽
Keisuke Watanabe,a Masaharu Shinkai,a,∗ Masahiro Shinoda,a Yoshiaki Ishigatsubo,b Takeshi Kanekoc
a
b
c
Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan
Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
a r t i c l e
i n f o
Article history:
Received 10 October 2013
Accepted 11 November 2013
Available online 8 October 2014
Keywords:
Intrapulmonary schwannoma
Endobronchial ultrasonography
Endobronchial ultrasound-guided
transbronchial needle aspiration
a b s t r a c t
A 47-year-old woman was referred to our hospital for further examination of a lung tumor. CT of the
chest revealed a round, well-defined 2.4-cm nodule in S2, adjacent to right superior lobe bronchus.
Endobronchial ultrasonography showed a well-defined, hypoechoic tumor with echogenic capsule and
posterior acoustic enhancement. Diagnosis of schwannoma was confirmed from the specimen obtained
by endobronchial ultrasound-guided transbronchial needle aspiration. She underwent tumorectomy
due to the possibility of obstructive pneumonia. Pathology diagnosis from the surgical specimen was
also schwannoma. Endobronchial ultrasound-guided transbronchial needle aspiration and findings with
endobronchial ultrasonography might be helpful in the diagnosis of intrapulmonary schwannoma.
© 2013 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.
Un caso de schwannoma intrapulmonar diagnosticado mediante aspiración
por punción transbronquial guiada con ecografía endobronquial
r e s u m e n
Palabras clave:
Schwannoma intrapulmonar
Ecografía endobronquial
Aspiración por punción transbronquial
guiada con ecografía endobronquial
Una mujer de 47 años fue remitida a nuestro hospital para un estudio diagnóstico de un tumor pulmonar.
La TC de tórax reveló la presencia de un nódulo redondeado, bien definido, de 2,4 cm en S2, adyacente al
bronquio del lóbulo superior derecho. La ecografía endobronquial mostró un tumor hipoecogénico, bien
definido, con una cápsula ecogénica y un refuerzo acústico posterior. El diagnóstico de schwannoma se
confirmó con el material obtenido mediante aspiración por punción transbronquial guiada con ecografía
endobronquial. Se practicó a la paciente una tumorectomía porque existía la posibilidad de una neumonía
obstructiva. El diagnóstico anatomopatológico de la pieza quirúrgica fue también de schwannoma. La
aspiración por punción transbronquial guiada con ecografía endobronquial y los resultados de la ecografía
endobronquial podrían ser útiles para el diagnóstico de un schwannoma intrapulmonar.
© 2013 SEPAR. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.
Introduction
Case Presentation
Intrapulmonary schwannoma is a rare tumor that is usually
diagnosed by postoperative pathological examination. We present
a case of intrapulmonary schwannoma diagnosed by endobronchial
ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).
A 47-year-old woman was referred to our hospital for diagnostic
testing of a lung tumor. She had undergone right thyroid lobectomy for papillary thyroid adenocarcinoma two years previously.
The patient was afebrile with no palpable lymph nodes, and her
vital signs and pulmonary auscultation were normal. Biochemistry
and hematology tests were unremarkable. Chest X-ray showed a
2-cm nodule in the upper right lung field. Chest computed tomography (CT) (Fig. 1A and B) revealed a round, well-defined 2.4-cm
nodule in S2, adjacent to the right upper lobe bronchus. A submucosal lesion and almost complete occlusion of the right upper
lobe bronchus were identified on bronchscopy. EBUS showed a
well-defined hypoechoic tumor, with an echogenic capsule and
夽 Please cite this article as: Watanabe K, Shinkai M, Shinoda M, Ishigatsubo
Y, Kaneko T. Un caso de schwannoma intrapulmonar diagnosticado mediante
aspiración por punción transbronquial guiada con ecografía endobronquial. Arch
Bronconeumol. 2014;50:490–492.
∗ Corresponding author.
E-mail address: [email protected] (M. Shinkai).
1579-2129/$ – see front matter © 2013 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.
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K. Watanabe et al. / Arch Bronconeumol. 2014;50(11):490–492
491
Fig. 1. Chest CT revealed a round, well-defined 2.4-cm nodule in S2, adjacent to the right upper lobe bronchus (A, B). EBUS showed a well-defined hypoechoic tumor, with
an echogenic capsule and posterior acoustic enhancement (C, D).
posterior acoustic enhancement (Fig. 1C and D). Nerve continuity was not detected. EBUS-TBNA was performed, as a histological
diagnosis may have been difficult to obtain with transbronchial
biopsy. The EBUS-TBNA sample showed hypercellular areas with
proliferation of fusiform cells and hypocellular areas (Fig. 2A and
B). Immunostaining for S-100 was positive (Fig. 2C), and a diagnosis
of schwannoma was confirmed. Rapid on-site cytologic evaluation
was not performed. The patient underwent tumorectomy due to
the possibility of obstructive pneumonia. Pathological examination of the surgical specimen further supported the diagnosis of
schwannoma.
Discussion
Pathological diagnosis is generally important in choosing the
treatment plan for lung tumors. Conventional bronchoscopy is
extensively used to obtain samples for pathological examination,
but it is impossible to biopsy intrapulmonary tumors situated
beyond the reach of the bronchoscope. In these cases EBUS-TBNA, a
relatively safe technique with a complication rate of 1.23% is often
useful for establishing the diagnosis.1 Moreover, its sensitivity and
specificity for the diagnosis of intrapulmonary lesions are 94.1% and
94.3%,2 respectively.
Positron emission tomography (PET) with 2-deoxy-2[18F]fluoro-d-glucose (FDG) is widely used to identify malignant
lesions, with a sensitivity and specificity of 96.8% and 77.8%,
respectively.3 However, schwannoma shows a high level of FDG
uptake in some cases, although it is a benign tumor,4 making
it difficult to differentiate it from malignant tumors using PET.
Intrapulmonary schwannoma is usually diagnosed by postoperative pathological examination; no cases of intrapulmonary
schwannoma diagnosed by EBUS-TBNA have been described. In
our patient however, this procedure facilitated diagnosis, while
preoperative pathological diagnosis was useful for performing
the tumorectomy. EBUS-TBNA might therefore be helpful for the
diagnosis of intrapulmonary schwannoma and for establishing the
treatment plan.
On ultrasound, schwannoma is a well-defined hypoechogenic
tumor.5 In some cases an echogenic capsule, posterior acoustic
enhancement and nerve continuity are also detected.5 However,
these characteristics are typical of schwannoma located in the
limbs or near the surface of the body. As far as we know, identification of an intrapulmonary schwannoma with endobronchial
Fig. 2. The sample obtained by EBUS-TBNA showed hypercellular areas with proliferation of fusiform cells and hypocellular areas (A) hematoxylin and eosin staining, ×100,
(B) hematoxylin and eosin staining, ×200. (C) Immunostaining for S-100 was positive ×200.
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492
K. Watanabe et al. / Arch Bronconeumol. 2014;50(11):490–492
ultrasound has not hitherto been described. In our case, it showed
a well-defined hypoechogenic encapsulated mass, with posterior acoustic enhancement, although nerve continuity was not
detected. These characteristics could be useful for diagnosing a
tumor of nerve origin in the lung.
In summary, we present the first case of intrapulmonary
schwannoma diagnosed by EBUS-TBNA. This procedure together
with endobronchial ultrasound findings might be helpful for the
diagnosis of intrapulmonary schwannoma.
Conflict of Interest
None.
Acknowledgement
Authors thank to Ms. Yoriko Inoue for her editorial support.
References
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